Many news stories about measles or vaccines quote these statistics, often with a prominent doctor saying it.

These figures have for a while struck me as odd because the death rate from measles in the US was more like one in 10,000 cases in the decade before widespread measles vaccination (with a vaccine that worked) started in 1967. I also did a very rough calculation for Australia and got a similar result.

Could they be talking world-wide? I don’t think so—it does appear they are referring to rates in the first world.

Also, there have been very few, if any, deaths from measles in first-world nations for many years if not decades. How on earth can they come up with such precise figures for the present day, when there have been far too few measles cases and measles deaths for drawing conclusions? They obviously can’t. But let’s look at some data.

The figures

The figures quoted today by health authorities appear to come from surveillance data of measles from 1985 to 1992 in the US, when there were many thousands of measles cases and quite a few deaths (the worst period 1989-1991 had 55,622 cases and 123 deaths).

They are reported in the CDC’s measles Pink Book under the heading ‘Complications’.

There have been other outbreaks in first-world nations since then (US, UK, Netherlands), but none with enough cases or deaths for drawing conclusions, so it does appear the CDC are mainly using the 1985-1992 data for their measles complications figures.

Reported cases

The 1985 to 1992 data shows there was encephalitis in 0.1% of reported cases (1 in 1000) and deaths were at 0.2% of reported cases (1 in 500), see table on the right.

The first thing that caught my attention was that the data was of reported measles cases. Really? Authorities are promoting figures gathered from reported cases only?

Or the doctor does suspect ‘measles’ but follows CDC guidelines and does not order the strict pathology test if the patient has been vaccinated? The guidelines say:

To minimize the problem of false-positive laboratory results, it is important to restrict case investigation and laboratory tests to patients most likely to have measles (i.e., those who meet the clinical case definition, especially if they have risk factors for measles, such as being unvaccinated,…

Also, the efficiency of reporting for measles deaths may be higher than for all measles cases, which would artificially inflate the estimated DCRs.

We do know that in the current era, authorities go to great lengths to hunt down and report any measles death they find. So all up, I think it would be fair to say measles cases are very under-reported, while measles deaths are much more likely to be reported, making the real death-to-case-ratio much lower than 1 in 500.

Incidentally, the article about measles mortality reporting above points out the high death-to-case ratio of the 1989 period was associated with patients having pre-existing immune deficiency such as AIDS:

The 1989 resurgence was the first measles epidemic in the United States since the beginning of the AIDS epidemic; the AIDS epidemic may have contributed to the high DCRs observed in this study.

This speaks for itself, really.

Before the vaccine

Before the measles vaccine, virtually all children had measles by the time they were 15, and most by the time they were 9. Then they had life-long immunity – they did not catch measles again.

As I mentioned earlier, deaths in the decade before the vaccine were around 1 in 10,000 cases in the US. We can see this in an article written in 1962 by Dr. Alexander Langmuir, chief epidemiologist at the CDC at the time. It is called The Importance of measles as a health problem, and Langmuir was attempting to convince fellow doctors it was worth developing a vaccine to target measles.

He was doing this because the predominant feeling amongst health professionals was that measles was a mild disease and intervention was not needed, and they also felt parents, who saw measles as a routine part of childhood, would not welcome another vaccine.

Remember at this time doctors were very pleased with themselves over their vaccines for diphtheria, tetanus, whooping cough and polio, diseases which they did believe were serious.

Langmuir produces a case fatality ratio graph, in Figure 3. We can see less than 10 in 100,000 cases (1 in 10,000) died for most age groups. Only young infants had a higher death rate, but it was not common for those to catch measles at that time.

The CDC even say in the Pink Book (under Secular Trends in the United States) that before the vaccine, cases were much higher than reported, here:

Before 1963, approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually.

So I’ll do some arithmetic, assuming deaths were recorded accurately:

500 deaths in 3,500,000 cases = 1 in 7,000

The CDC also state elsewhere that there were 400 to 500 deaths per year in the decade before the vaccine – if you use 450 the death rate is 1 in 7,777.

This range of estimations is supported by Babbott and Gordon in ‘Modem measles’. American Journal of Medical Science 1954; 228:334-361, reported here:
“Whatever its toll in industrialized countries, where the measles fatality rate is 1 per 10,000 cases (Babbott and Gordon, 1954)…”

Such high levels of transmissibility mean that when the percentage of children in a community who have received the measles vaccine falls below 90 percent to 95 percent, we can start to see major outbreaks, as in the 1950s when four million Americans a year were infected and 450 died.

That makes a death to case ratio of 1 in around 9,000, not 1 or 2 in 1000. I wonder if he thought about that.

Alexander Langmuir also gives weight to the argument measles was considered a mild disease in the pre-vaccine era in his closing remark in his article mentioned above. He says:

To those who ask me, “Why do you wish to eradicate measles?” I reply with the same answer that Hilary used when asked why he wished to climb Mt. Everest. He said “Because it is there.” To this may be added “…and it can be done.”

To be honest it sounds like ego and justifying his position to me.

Then there is this letter from a doctor asked to report on measles in his practice, and published in the British Medical Journal in 1959:

In the majority of children the whole episode has been well and truly over in a week, from the prodromal phase to the disappearance of the rash, and many mothers have remarked “how much good the attack has done their children,” as they seem so much better after the measles. . . In this practice measles is considered as a relatively mild and inevitable childhood ailment that is best encountered any time from 3 to 7 years of age. Over the past 10 years there have been few serious complications at any age, and all children have made complete recoveries. As a result of this reasoning no special attempts have been made at prevention even in young infants in whom the disease has not been found to be especially serious.

“If we didn’t have vaccination at all, we would have a quarter of a million cases of measles on average every year.”

and

“One in 500 could die and one in 500 could end up with a nasty brain infection.”

Well, if we have 250,000 cases in a year, and 1 in 500 “could” die, he is suggesting there “could” be 500 deaths per year.

That is astonishing really, when you consider that in the 10 years 1956 to 1965, just before Australia’s introduction of measles vaccination in 1970, there were 210 measles deaths altogether, according to this government document, page S1 (Table 1.1)

Here’s the table:

That’s an average of 21 per year. According to the table, Australia’s population was around 11 million in that decade, which is about half what it is now.

If we assume that if we had never had the vaccine, the measles death/population rate today would be the same as it was in the 1950s and 60s, then Booy’s estimation is out by a factor of a whopping 12 (double 21 to allow for total population growth, giving 42 deaths per year, not Booy’s 500 per year. Then divide 500 by 42 = 12).

I wonder if Booy has bothered to look at these figures, and if he has, what his explanation for them would be.

Actually, while we are looking at Table 1.1 in that Australian government document, have a look at the sharp decline in measles deaths over the decades before the vaccine, while the population nearly doubled. How many deaths do you reckon there would be today if there had been no measles vaccine?

That rather plays havoc with Booy’s numbers, doesn’t it?

Our Professor Booy also said in this video that “thousands and millions” of children have died from measles, in an attempt to emphasise the danger of measles.

What is he talking about? We had 21 deaths per year from measles in Australia, about 450 per year in the US and around 100 per year in the UK, over the decade before the vaccine – where were the thousands and millions? The nineteenth century? The third world? How are they relevant?

Measles complications

It should be obvious that if measles deaths were declining steeply in the decades up until 1970, then those complications that didn’t result in death, such as pneumonia and encephalitis, would have been coming down too, and would have continued to do so without the vaccine. Because it is the complications that cause death.

With encephalitis, the authorities say the vaccine lowered measles encephalitis, and this is true, because with measles cases drastically reduced, there had to be fewer cases of measles encephalitis.

To see if the measles vaccine was really of benefit regarding encephalitis, we would need to look at encephalitis cases from all causes, before and after the measles vaccine.

A Finnish researcher did this, and found that measles vaccination reduced the rate of encephalitis cases from all causes, but did not reduce the number of severe cases. And the rate from all causes increased again anyway, after a few years, because encephalitis is a disease of susceptibility—any number of pathogens can cause it, and if one is removed others will step up to the plate in a susceptible person. For an explanation see this video (24:50 to 29:30) and these papers: here and here.

Of course, it is always possible the vaccination program has made measles more dangerous than it was pre-vaccine, for those who catch it. It looks to me like it has, though not nearly as much as the CDC’s figures would indicate. I’ll be looking at that in a post to come, about herd immunity.

Comments

Dave – firstly, you misunderastand. The prevaccine figures are 1 death in 10,000 measles cases, not population – very different from the scare-mongering of today, where they say one or two deaths per 1000 cases. Secondly, many, many people say they or their children have serious reactions to vaccines and it is not reported.